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Low-Risk Human Papillomavirus Testing and Other Nonrecommended Human Papillomavirus Testing Practices Among U.S. Health Care Providers

Lee, Jennifer Wai-Yin RN, BS; Berkowitz, Zahava MSPH, MSc; Saraiya, Mona MD, MPH

doi: 10.1097/AOG.0b013e3182210034
Original Research

OBJECTIVE: To assess self-reported human papillomavirus (HPV) DNA testing practices by health care providers and clinics, including nonrecommended practices such as low-risk HPV testing, HPV cotesting in women younger than age 30 years, and HPV reflex testing for high-grade abnormal Pap test results.

METHODS: We analyzed responses to a cross-sectional survey of a nationally representative sample of Papanicolaou test providers administered in conjunction with the 2006 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Data analysis was performed on responses from 376 office-based health care providers and 216 outpatient clinics.

RESULTS: Overall, 75.5% (95% confidence interval [CI] 68.7–81.2%) of health care providers and 77.2% (95% CI 60.3–88.3%) of clinics reported ever using the HPV DNA test. Of health care providers who used HPV testing, 28.5% (95% CI 21.6–36.6%) used both high-risk and low-risk HPV tests. Most health care providers (59.6%, 95% CI 48.5–69.7%) and clinics (66.0%, 95% CI 48.0–80.3%) used HPV cotesting in women younger than age 30 years. A high percentage of health care providers and clinics performed reflex HPV testing after Pap test results of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions (71.4%, 95% CI 63.5–78.3% and 62.8%, 95% CI 49.0–74.9%, respectively) and high-grade squamous intraepithelial lesions (50.7%, 95% CI 42.4–58.9% and 49.0%, 95% CI 33.1–65.2%, respectively), results for which HPV testing is not recommended.

CONCLUSION: Many health care providers reported inappropriate uses of HPV testing, which may lead to unnecessary follow-up and increased medical costs without added benefits. Interventions such as eliminating the low-risk HPV test from the U.S. market and educating health care providers and patients on appropriate indications for HPV testing are needed to discourage health care providers from such practices.


Human papillomavirus testing practices that are not recommended by any guidelines, such as low-risk human papillomavirus testing, are common.

From the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; The CDC Experience Applied Epidemiology Fellow, Scientific Education and Professional Development Program Office, and the National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

See related editorial on page 1.

Jennifer Wai-Yin Lee completed this project during a 1-year fellowship with The CDC Experience, a public/private partnership supported by a grant to the CDC foundation from the External Medical Affairs, Pfizer Inc.

The findings and conclusions of this study are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Corresponding author: Mona Saraiya, MD, MPH, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, Mailstop K-55, Atlanta, GA 30341; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.